Lack of protection of N-acetylcysteine (NAC) in acute renal failure related to elective aortic aneurysm repair—a randomized controlled trial

Background. N-acetylcysteine (NAC) is an antioxidant drug largely tested in different clinical situations. Recently, NAC has been employed with variable success in the prevention of radiocontrast nephropathy. Since aortic aneurysm surgical repair is a condition that is frequently accompanied by acut...

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Published in:	Nephrology, dialysis, transplantation Vol. 21; no. 7; pp. 1863 - 1869
Main Authors:	Macedo, Etienne, Abdulkader, Regina, Castro, Isac, Sobrinho, Augusto C. C., Yu, Lius, Vieira, Jose M.
Format:	Journal Article
Language:	English
Published:	Oxford Oxford University Press 01-07-2006 Oxford Publishing Limited (England)
Subjects:	Acetylcysteine - metabolism Acetylcysteine - pharmacology Acute Kidney Injury - drug therapy acute renal failure Adolescent Adult Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy aortic aneurysm Aortic Aneurysm - surgery Aortic Aneurysm - therapy Biological and medical sciences Double-Blind Method Emergency and intensive care: renal failure. Dialysis management Female Free Radical Scavengers - pharmacology Humans Intensive care medicine ischaemia Ischemia - pathology Male Medical sciences Middle Aged N-acetylcysteine Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Placebos randomized controlled trial Renal failure surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Treatment Outcome Kidney disease Thiol Urinary system disease Hemodialysis Aneurysm Acetylcysteine Cardiovascular disease N-acetylcysteine randomized controlled trial Vascular disease Extrarenal dialysis Mucolytic aortic aneurysm ischaemia acute renal failure Surgery Renal failure Aorta
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Summary:	Background. N-acetylcysteine (NAC) is an antioxidant drug largely tested in different clinical situations. Recently, NAC has been employed with variable success in the prevention of radiocontrast nephropathy. Since aortic aneurysm surgical repair is a condition that is frequently accompanied by acute renal failure (ARF), we sought to investigate whether NAC has any role in preventing ARF in this scenario. Methods. A randomized, placebo-controlled, double-blind trial with the following inclusion criteria: elective aortic aneurysm repair in patients with stable renal function. The groups were randomly matched for age, gender, presence of diabetes and pre-existent renal failure. NAC or placebo (control) was administered p.o. for 24 h before operation and maintained i.v. for 48 h after operation. The dose of NAC was 1200 mg b.i.d. the day before surgery and 600 mg b.i.d. after. The primary endpoint was the development of ARF up to the third post-operative day, defined as an increase in SCr ≥ 25% from baseline. Secondary endpoints were: ICU mortality and ICU length of stay. Results. Forty-two patients (n = 18 for NAC group and n = 24 for control) were studied. The baseline SCr and calculated GFR did not differ between the groups (1.19±0.33 vs 1.37±0.49 mg/dl; and 64.6±26.22 vs 65.7±28.32 ml/min, NAC vs control, respectively, P = 0.17 and P = 0.90). Need for suprarenal aortic cross-clamping and its duration, occurrence of major bleeding, intra-operative hypotension and the post-operative peak of CPK did not differ between NAC and control groups. The overall incidence of ARF in the study was 36% (13/36), but it was not significantly different between groups (7/14, 50% in NAC vs 6/22, 27.3% in control, P = 0.16). The overall mortality was 23% (10/42) and was not different (P = 0.209) in NAC group (33.3%) when compared with control (16.7%), the same occurring with the length of ICU stay (2.93±1.53 vs 2.52±1.36 days, P = 0.40). Conclusion. This study suggests that the putative beneficial effects of NAC on radiocontrast nephropathy might not be applicable to other situations, such as ARF associated with elective aortic aneurysm repair.
Bibliography:	Correspondence and offprint requests to: Dr José M. Vieira, Jr, Av. Dr Arnaldo 455, Sala 3342, CEP 01246-903, São Paulo-SP, Brazil. Email: josemvjr@usp.br ark:/67375/HXZ-3ZZM0154-W istex:D49F19E9B8494536F64077BFAB5664B2A1534D26 local:gfl079 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23
ISSN:	0931-0509 1460-2385
DOI:	10.1093/ndt/gfl079